Insurance denied me AGAIN - I am so frustrated — 12 month update

amsterdam_pete said:

NeuroNate said: ...compounded vs brand cost and coverage...

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.

NeuroNate said:

The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from…

Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 2 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (T2DM + hypertension), and referencing the SELECT trial data.

If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.

NurseKim_ATL said:

The affordability discussion here usually stops at individual tactics.

My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.

Following on from mia_MS2 — and this may be the naive question:

How would you tell the difference between that and the alternative explanation?

Closing the loop on my own question.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.